Cigarette Smoking History and Functional Outcomes After Spontaneous Intracerebral Hemorrhage

Abstract

Background and Purpose: While cigarette use may be a risk for intracerebral hemorrhage (ICH), animal models suggest that nicotine has a potential neuroprotective effect. The aim of this multicenter study is to determine the effect of smoking history on outcome in ICH patients. Methods: We analyzed prospectively collected data from the Ethnic/Racial Variations of Intracerebral Hemorrhage study, and included patients with smoking status data in the analysis. Patients were dichotomized into non-smokers versus ever-smokers, and the latter group was further categorized as former (>30 days before ICH) or current (≤30 days before ICH) smokers. The primary outcome was 90-day modified Rankin Scale (mRS) score shift analysis. Secondary outcomes were in-hospital mortality and mortality, Barthel Index, and self-reported health status measures at 90 days. Results: The overall study cohort comprised 1,509 non-smokers and 1,423 ever-smokers (841 former, 577 current, 5 unknown). No difference in primary outcome was observed between nonsmokers versus ever-smokers (aOR=1.041 [0.904-1.199], p=0.577). No differences in primary outcome were observed between former (aOR=0.932 [0.791-1.178], p=0.399) or current smokers (aOR=1.178 [0.970-1.431], p=0.098) versus non-smokers. Subgroup analyses by race/ethnicity

A prognostic nomogram incorporating red cell distribution width for patients with intracerebral hemorrhage

“…[ 37 , 42 – 44 ] The reason might be attributed to racial and socioeconomic differences, suggesting multi-nation and multi-center research to eliminate the potential bias. [ 45 – 48 ] Fourth, the data of therapeutic intervention was unavailable. As we know, medicine treatment plays a crucial role in ICH patients, notably patients without surgery.…”

Tobacco Use: A Major Risk Factor of Intracerebral Hemorrhage

“…However, cigarette smoking and nicotine had a detrimental effect in sICH patients in clinical studies ( Table 1 ) and in animal models from our laboratory (data not published). Some clinical studies also confirmed that no beneficial effect was seen after 3 months in sICH smoking patients [ 112 , 113 ]. The procoagulant benefit of cigarette smoking does not seem to be enough to overcome its detrimental effects.…”

“…Some clinical studies also confirmed that no beneficial effect was seen after 3 months in sICH smoking patients. 112,113 The procoagulant benefit of cigarette smoking does not seem to be enough to overcome its detrimental effects.…”

Intracerebral haemorrhage: from clinical settings to animal models

“…The worldwide annual incidence of spontaneous ICH is 12–35 per 100 000 population, which accounts for approximately 15% of cerebral strokes; it has a higher mortality rate compared with that of cerebral ischaemia. 13 The major high-risk factors for ICH are an elderly population, 14 male sex, 15 current smoking, 16 excessive alcohol consumption, 17 low total cholesterol level, 18 long sleep duration, 19 illicit drug use, 20 Asians ethnic origin 21 and genetic factors. 22 Other clinical disease can cause ICH, including hypertension, 23 coagulopathy, 24 cerebral amyloid angiopathy (CAA), 25 cerebral tumours, 26 intracranial arterial aneurysm, 27 vascular anomalies, 28 brain trauma, 29 premature birth, 30 haemorrhagic conversion of stroke, 31 posterior reversible encephalopathy syndrome, 32 vasculitis, 33 infective endocarditis, 34 dural arteriovenous fistula, 35 brain arteriovenous malformation, 36 cavernous malformation 37 and intracranial venous thrombosis 38 ( figure 1 ).…”